RESUMEN
A 71-year-old man presented with a painful swelling of the tip of his little finger. Infection was considered, but antibiotics and incision did not give relief. Biopsy showed metastasis of anal carcinoma, for which he had been treated 7 years earlier with curative chemoradiotherapy. He underwent amputation of the finger.
Asunto(s)
Neoplasias del Ano/patología , Carcinoma/secundario , Dedos/patología , Anciano , Amputación Quirúrgica , Neoplasias del Ano/terapia , Biopsia , Carcinoma/patología , Carcinoma/cirugía , Quimioradioterapia , Dedos/cirugía , Humanos , MasculinoRESUMEN
BACKGROUND AND OBJECTIVE: The Multicenter Selective Lymphadenectomy Trial (MSLT-I) demonstrated that the sentinel node (SN) status in cutaneous melanoma affects prognosis and that completion lymphadenectomy in SN-positive patients may improve survival. Our objective was to evaluate sentinel lymph node biopsy (SLNB) in two regional hospitals in the Netherlands. METHODS: Patients with localized melanoma were planned for wide excision and SLNB. Completion lymphadenectomy was recommended for positive SN status. Data were compared with the MSLT-I. RESULTS: A median of 2 (1-7) SNs were identified in 305 patients and complications occurred in 11%. Fifty-four patients (18%) demonstrated SN metastases and 45 underwent completion lymphadenectomy (20% additional metastases). Six patients with initially negative SN developed lymph node metastases (sensitivity 90%). Overall disease-free survival was 83% (SN-negative 91% vs. SN-positive 41%; p < 0.001) and melanoma-specific survival was 93% (SN-negative 97% vs. SN-positive 62%; p < 0.001). Multivariate regression analysis revealed the SN status to be the most significant predictor for recurrence and melanoma-related death. CONCLUSION: Our results of SLNB are comparable to data from high-volume centers participating in MSLT-I. From a patient perspective, the false-negative SN rate of 10% and complication rate of 11% should be weighed against being informed about prognosis and having a possible therapeutic benefit from completion lymphadenectomy.
Asunto(s)
Metástasis Linfática/diagnóstico , Melanoma/diagnóstico , Biopsia del Ganglio Linfático Centinela , Neoplasias Cutáneas/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Metástasis Linfática/patología , Masculino , Melanoma/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Países Bajos , Pronóstico , Neoplasias Cutáneas/patología , Tasa de Supervivencia , Melanoma Cutáneo MalignoRESUMEN
BACKGROUND: Sacrococcygeal teratomas are neoplasms that are ordinarily diagnosed intrauterinely. In case of complete or partial intrapelvic sacrococcygeal teratoma, it may happen that it is only ascertained at a later age. CASE DESCRIPTION: During a regular monitoring visit for breast cancer a 58-year-old female reported that she had discovered a swelling at the level of her coccyx. MRI imagery appeared to indicate an ectopic ovary. After resection, it appeared that it was a mature teratoma from which mucinous adenocarcinoma had developed. CONCLUSION: Given the risk of malignant deterioration, it is important that sacrococcygeal teratoma be recognized and treated by means of complete resection, including resection of the coccygeal bone.
Asunto(s)
Coristoma/diagnóstico , Neoplasias Ováricas/diagnóstico , Región Sacrococcígea , Teratoma/diagnóstico , Coristoma/cirugía , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/cirugía , Teratoma/cirugía , Resultado del TratamientoAsunto(s)
Adenocarcinoma/complicaciones , Intususcepción/etiología , Neoplasias del Yeyuno/complicaciones , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Anciano de 80 o más Años , Diagnóstico Diferencial , Endoscopía Gastrointestinal , Femenino , Humanos , Intususcepción/diagnóstico , Intususcepción/cirugía , Enfermedades del Yeyuno/diagnóstico , Enfermedades del Yeyuno/etiología , Enfermedades del Yeyuno/cirugía , Neoplasias del Yeyuno/diagnóstico , Neoplasias del Yeyuno/cirugía , Laparotomía/métodos , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: Mechanical bowel preparation is common practice in elective colon surgery. In recent literature the value of this procedure is under discussion. To verify the value of mechanical bowel preparation in elective open colon surgery, a randomized clinical trial was conducted. METHODS: During a prospective, multicenter, randomized study, 250 patients undergoing elective open colon surgery were randomized between receiving mechanical bowel preparation with polyethylene glycol (PEG group, 125 patients) and having a normal meal preoperatively (normal meal preoperatively group, 125 patients). Outcome parameters were wound infection with bacterial results of intraoperative swabs and anastomotic leak. RESULTS: In the polyethylene glycol group there were a total of nine wound infections (7.2 percent) and seven anastomotic leaks (5.6 percent) compared with seven wound infections (5.6 percent) (P = 0.61) and six anastomotic leaks (4.8 percent) (P = 0.78) in the normal meal preoperatively group. Bacterial results showed 52 percent sterile subcutis swabs in the PEG group and 63 percent sterile subcutis swabs in the normal meal preoperatively group (P = 0.11). CONCLUSION: In the present study we could not detect a difference in outcome parameters between patients receiving mechanical bowel preparation in elective open colon surgery and patients without preoperative treatment of the bowel. The present study, although underpowered, did not show a difference in the primary outcome of bacterial wound cultures between patients receiving preoperative mechanical bowel preparation and patients receiving no preoperative bowel treatment. We conclude that there may be no need to continue the use of mechanical bowel preparation in elective open colon surgery.